The discovery and creation of medicines have been an essential aspect of the human experience since 2600 BCE. Without the development of medicines and treatments like aspirin, smallpox vaccinations, and anesthesia, both the history and the future of the human race would be very different. These treatments, however, have not been universally accessible because of differences in health infrastructure, the sharing of knowledge and patents, and international and intranational wealth inequality between social classes. Fortunately, this is changing. Since the late 19th and early 20th century, international migration and collaboration in the fields of medical technology and travel have facilitated the globalization of healthcare. As a result, medical tourism has emerged as a solution to make available previously inaccessible healthcare.
What is medical tourism?
Medical tourism is “the movement of patients across borders in the pursuit of medical treatment and health care,” according to a report by the Organisation for Economic Co-operation and Development (OECD). In 2017, nearly 1.4 million Americans travelled abroad to seek healthcare treatment that is less expensive and available with shorter wait times compared to what the American private health system offers. In 2018, Thailand’s medical tourism industry surpassed $600 million in valuation and became the fourth-most popular destination in the world for medical tourism.
Among the ten most visited destinations for medical care, 7 are non-Western countries and are typically less developed countries than North American or European countries. These countries – India, Malaysia, Singapore, South Korea, Taiwan, Thailand, and Turkey – are tourist attractions for those without sufficient insurance coverage. Such coverage may exclude elective procedures, including cosmetic and dental surgery. Alternatively, many people do not have health insurance at all and cannot afford healthcare in their home countries. In such a situation, medical tourism is a viable option.
The legacies and opportunities of medical tourism in India
India is one of the most popular global destinations for medical tourists seeking cardiac and orthopedic surgery. As of 2019, India had 619 internationally accredited hospitals under the National Accreditation Board for Hospitals and Healthcare Providers (NABH).
A 2019 Ernst and Young report (EY) predicted India’s medical tourism industry would expand to $9 billion in 2020. For private hospitals, like Medanta in Gurugram, India, the growth in foreign demand for medical services means an increased flux of foreign capital.
Further reports from EY aren’t yet available, but this increase in revenue could mean a profit margin that could be directed towards creating more affordable healthcare systems for the local populace. However, most medical tourists visit private hospitals for high-quality care, so the fees they pay do not benefit low-income communities or local health policies, which are under the direction of the government.
This rigid separation of private and public healthcare is the legacy of colonially-introduced capitalism in India. The capitalist economic model was introduced to India by the British when raw materials from India like iron ore, coal, spices, and textiles began being exported extensively to Europe in 1869. The extraction and production of these commodities were widely done by Indian labourers, who were given next to nothing as payment for their grueling and difficult work.
Over the nearly three centuries that the British ruled India, this system of exploitation became ingrained in the economy. The division of public and private property is central to this system. In a nutshell, the colonial reforms to the Indian economy led to an increase in the privatisation of resources and financial capital available to landlords and industrialists, who were wealthy even prior to the reforms. Subsequently, the working class of peasants, farmers, and traders who constituted the “public,” received limited or no access to resources like healthcare.
Fast forward to the present, and this legacy continues in the form of steep resource inequality and a lack of government involvement in the collaboration between public and private entities. In the case of hospitals, this legacy means a lack of sharing of resources, unequal access to medical technology, and unaffordable quality healthcare for the working class of India.
India under the microscope: healing public health policy with medical tourism
As of 2020, India’s healthcare system remains underfunded even with public health schemes in place to boost accessibility and affordability. A potential solution to this problem is changing the colonial practice of privatisation and partially integrating private providers of healthcare in public healthcare policy.
The Indian public and private health sectors only have insurance providers in common, wherein public and private insurance expenditures combined represent about 3.9% of India’s Gross Domestic Product (GDP). Theoretically, and in terms of GDP, this means the additional revenue generated by an increase in medical tourists accessing India’s private healthcare sector could be directed towards funding for the public healthcare sector to make insurance accessible. This does not mean a removal of the public and private distinction in healthcare, but rather a direction of some taxable revenue from the private healthcare sector into the public sector as funding for improved infrastructure.
The World Health Organization reported that a wastage of healthcare funding, of which one kind is misappropriated expenditure, is one of the leading causes of inefficiencies in public healthcare systems. A reduction of expenditure wastage in private Indian hospitals would entail healthcare providers like Medanta, Apollo, and Max Hospital to increase their quota spending or the expenditure that is allotted to public health services for low-income communities outside government schemes.
To boost public health policy, this excess expenditure and revenue generated from medical tourists can be funneled into public health institutions by implementing a minimal tax on foreign health expenditure at private institutions.
States or the central government could levy the tax and instead of investing it into insurance schemes for the public, they could directly invest it into building tangible public health infrastructures like services and technology, and increasing hospital capacity and density nationwide.
Encouraging private for-profit healthcare providers to incentivize medical tourism will not only increase revenue for the private sector, but might also increase public investment, trust, and government support in research and resource provision. This could effectively transform the public health sector in India with the injection of private profits from foreign patients into the public sector.
The privatisation of medicine began as a colonial practice that took away from the poorer public, but integrating private and public sectors at several points like insurance and physical infrastructure could instead utilize this colonial legacy for equitable access to healthcare in India.